Prognosis of invasive intraductal papillary mucinous neoplasms of the pancreas

摘要

Intraductal papillary mucinous neoplasms(IPMN) are mucin producing cystic neoplasms of the pancreas histologically classified as having non-invasive and invasive components.The five-year survival rates for non-invasive and associated invasive carcinoma are 90% and 40%,respectively in resected IPMN lesions.Invasive carcinoma within IPMN lesions can be further classified by histological subtype into colloid carcinoma and tubular carcinoma.Estimated five-year survival rates following resection of colloid carcinoma range from 57%-83% and estimated five-year survival following resection of tubular carcinoma range from 24%-55%.The difference in survival outcome between invasive colloid and tubular IPMN appears to be a function of disease biology,as patients with the tubular subtype tend to have larger tumors with a propensity for metastasis to regional lymph nodes.When matched to resected conventional pancreatic adenocarcinoma lesions by the Memorial Sloan Kettering Cancer Center pancreatic adenocarcinoma nomogram,the colloid carcinoma histological subtype has an improved estimated five-year survival outcome compared to conventional pancreatic adenocarcinoma,87% and 23%(P = 0.0001),respectively.Resected lesions with the tubular carcinoma subtype overall have a similar five-year survival outcome compared to conventional pancreatic adenocarcinoma.However,when these groups were stratified by regional lymph node status patients with negative regional lymph nodes and the tubular subtype experienced significantly better survival than patients with a similar nodal status and ductal adenocarcinoma with estimated five-year survival rates of 73% and 27%(P = 0.01),respectively.